NEONATAL INVASIVE HERPES INFECTIONS. INBORN ERRORS OF IMMUNITY AND PHENOCOPIES AS PREDISPOSING FACTORS

Herpetic infection is a condition with high rates of neonatal morbidity and mortality; to date, there is no universally recognized strategy for the perinatal management of the risk of Herpes Simplex Virus (HSV) transmission based on the prognostic value attributed to maternal risk factors. Starting from the analysis of a clinical case of neonatal herpes meningoencephalitis, a literature review was conducted concerning the management of herpetic infection during pregnancy and in the neonatal period in terms of prevention and early diagnosis. The paper describes a case of a newborn with neonatal herpes meningoencephalitis transmitted by a mother with recurrent herpetic infection without clinically evident genital lesions at birth, despite the correct application of gynecological-neonatal protocols stratified by risk categories. An integrative model to the current guidelines should consider the following prophylactic strategies: performance of serological screening for HSV between the 24th and 28th week of pregnancy; provision of counseling regarding the main maternal-fetal and neonatal transmission risk factors for HSV; administration of antiviral prophylaxis with acyclovir to seropositive pregnant women starting from the 36th week of gestation; expansion of neonatal HSV-related screening tests even in cases where primary or recurrent genital lesions are present within ninety days before delivery. The diagnosis of neonatal herpetic meningoencephalitis suggests an underlying congenital error in innate immunity, related to an alteration in the TLR3/IFNα-β-λ axis, which presents with minimal/absent alterations in the immunological balance of I/II level, associated with infectious susceptibility to a restricted spectrum of viral pathogens, and deserves early immunological specialist evaluation.